持续灌注氧合血保存的离体猪肺缺血再灌注损伤体外评估  

The ex vivo evaluation of oxygenated blood continuous perfusion to prevent ischemic - reperfusion injury of donor lung

作　　者：龙小毛[1] 林辉[1] 贺榜福[1] 胡彦艳[1] 黄剑伟[1] 黄爱兰[1] 蒋伟[1] 钟永泷[1] Long Xiaomao;Lin Hui;He BanGfu;Hu Yanyan;Huang Jianwei;Huang Ailan;fiang Wei;Zhong Yonglong(Department of Thoracic and Cardiovascular Surgery,Guangxi Zhuang Autonomous Region People＇s Hospital,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院胸心外科,南宁530021

出　　处：《中华实验外科杂志》2018年第10期1807-1810,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金（81360020）

摘　　要：目的探讨氧合血体外持续灌注对离体供肺的保护作用。方法将Celsior液单次经肺动静脉灌注后的供肺，分为对照4个组（低温静态法，C4、C8、C12、C18组）及实验4个组（体外灌注法，T4、T8、T12、T18组）。保存后的离体供肺再与体外灌注系统及呼吸机连接工作6h，检测离体供肺通气阻力（LR）、左下肺静脉血氧分压（LIPV-PO2）、左下肺静脉血二氧化碳分压（LIPV-PCO2）、肺含水量（LWC）等肺功能指标，光镜观察肺水肿分级（LEC），原位末端标记（TUNEL）法检测细胞凋亡。结果肺功能评估：（1）体外灌注法肺功能相对稳定，T18组LR、LWC才显著高于T4组（P值分别为0．012、0．010）；低温静态法C12组LR、LWC已显著高于C4组（JP值分别为0．018、0．015）；相同时间点T12、T18的LR、LWC分别显著低于C12、C18（LR：P分别为0．025、0．028；LWC：P值分别为0．021、0．027）；（2）肺损伤评估：体外灌注法T18组LEC及凋亡细胞数显著高于C4组（P值分别为0．023、0．020）；低温静态法C12、C18组LEC显著高于c4组（P值分别为0．023、0．020），凋亡细胞数也显著增高（P值分别为0．015、0．011）；C18组LEC及凋亡细胞显著高于T18组（P值分别为0．007、0．026）。结论氧合血体外持续灌注可明显减轻低温保存供肺所致的时间依赖性缺血再灌注损伤，但仍需在完全生理状态下进行进一步评估。Objective To study the protective effect of ex vivo perfusion to prevent donor - lung injury. Methods After being flushed with Celsior solution, the donor lungs were divided to control group （4℃ cold static preservation, subgroups - C4, C8, C12, C18） and experimental group （ ex vivo oxygena- ted blood continuous perfusion, subgroups -T4, T8, T12, T18）. Then the donor lungs connected with ventilator and ex vivo perfusion system to worked for 6 h. Lung ventilation resistance （ LR）, the left inferi- or pulmonary vein blood PO2 （LIPV -PO2 ） , the left inferior pulmonary vein blood PCO2 （LIP~ -PCO2 ） , and lung water content （LWC）, were evaluated. Lung edema were studied by light microscopic observation and apoptotic cells （AC） were detected by terminal - deoxynucleotidyl transferase mediated nick end labe- ling （TUNEL）. Results Lung function evaluation ： （ 1 ） Lung function of experiment group was relatively stable, LR and LWC of T18 were significantly more than T4 （P =0. 012,0.010, respectively） ; LR and LWC of C12 were significantly more than CA （ P = 0. 018, 0. 015, respectively） ; In the same time point LR and LWC of T12 and T18 were significantly less than C12 and C18 respectively （LR： P = 0.025, 0. 028 ; LWC ： P = 0. 021, 0. 027 ; respectively） ; （ 2 ） Lung injury evaluation： pulmonary edema classifi- cation （LEC） and AC of T18 were significantly more than T4 （P = 0. 023, 0. 020, respectively） ; LEC and AC of C12 and C18 were significantly more than C4 （PLEC =0. 023, 0. 020; Psc =0. 015, 0. 011, respectively）; LEC and AC of C18 were significantly more than T18 （P= 0.007, 0.026, respectively）. Conclusion Ex vivo oxygenated blood continuous perfusion without ventilator ameliorates hypothermie time - dependent ischemic - reperfusion injury. But further systems evaluation in complete physiologic con- dition is necessary.

关 键 词：肺移植 供肺保存 肺损伤 体外灌注 

分 类 号：R563[医药卫生—呼吸系统]